Changes in GME funding an opportunity

[gbrothers98]

George, I like your apprenticeship idea, but they must be PAID, and the question is from where does that funding come?

Graduating PA students cannot afford to work for free any more than a graduating physician can. Student loan payments come due 6 months after graduation for all of us.

I am torn on the notion of extending PA training to 3 years when we have more 3-year MD and DO programs all the time. In fact the line between PA and physician training is becoming very blurry. I still maintain that the difference is the residency more than any preclinical curriculum--but I also agree that medicine has grown way too much and too fast for anyone to have a decent grasp on it in just a year or two of clinical clerkships. Students today are much more limited in what they are allowed to do as students--it was pretty shocking for me as a medical student to find how little I was allowed to do compared to my rotations as a PA student 15 years earlier. How on earth are these folks supposed to attain clinical competency without significant OTJ training and/or an internship?

Apprentices would be paid. A PA out of school, certified nationally and licensed in the state providing care to the patient can bill under their NPI #. I think this can subsidize the salary and there can also be time for education and experience building. This is why it is called an apprenticeship and not a residency. I think a salary level between a resident's salary and median PA salary could cover living expenses and also loans. There could also be loan forebearance for one year due to income. 

3 yr physician training programs are the exception and not the norm. A 3 yr physician program also comes with a hook, usually placement into a prechosen REQUIRED residency. When the 3 year program is reviewed, what is apparent is that vacations and time off is reduced with some minor changes to academic instruction. This is also an option open to a limited # of applicants, usually one or 2 a year. We wont see an abundance of 3 year med school grads anytime soon because they still have to match to residencies. I have not seen an announcement of residencies shortened nor more funding to open more positions so there still is a minimum of 3 more years till that doctor actually becomes a doctor, practicing outside of academic and federal constraints due to resident status. This is a machine that will only be tinkered with around the edges.

To obtain clinical competency, the name of the game now is simulation experience at least initially. The days of see one, do one, teach one are long gone. Increased utilization of this technology is paramount in education and any prospective PA student should be inquiring about this at any program they interview at.

Regard

G Brothers PA-C

[primadonna22274]

I just don't see that simulation training is anything like practicing on real actual PEOPLE. Look, I taught too, and half the time our sim models didn't work.

My 3-yr track was NOT linked to a predetermined residency. I entered the match and interviewed like everyone else. So did my counterparts in the 3-yr primary scholars program (who weren't prior PAs like me)--but their applications were much more narrow as they had significant contractual restrictions on where they could apply and do residency to be in compliance with their program.

If most of these (admittedly small) 3-yr med school tracks are in fact linked with residency programs in which they are de facto admitted to residency on completion of their med school curriculum, it seems a fine idea provided they get strong instruction. I was very choosy with my residency apps and pleased to match to such a strong program...I have much less faith in someone else choosing for me.

The next decade will be a game-changer for sure. I predict a fundamental change to a stem cell idea where PAs and MD/DOs are trained along a continuum and "get off the train" at certain steps along the way, if they choose to do so. At least this is my pipe dream. ☺️

[Guest Paula]

The GME report is long (206 pages if I recall) and is likely physician centric.  One news release I read from AAPA mentioned inter-professional training between MD/DOs and PAs and how to educate the physicians about  the MD led team with PAs.

 

I support funding for PAs for residency (or apprenticeship) and a 3 year PA program.  I like primadonna's pipe dream but the GME powers that be will probably put the NP into the stem cell line instead of us.  Were NPs mentioned in the report?

[primadonna22274]

I really don't see ACGME being interested in training NPs over PAs. These are physicians, mind you--they are medical model folks. Most of them understand that PAs are trained in the same model and we share a common lineage. Nursing is quite different and I really don't see the ANA militant folks wanting to play nice with physicians because they see themselves as a totally independent force that doesn't need physicians.

Stupid in that we are all terribly interdependent these days--nobody can practice medicine in a vacuum. There's just too much to know and do.

[gbrothers98]

I just don't see that simulation training is anything like practicing on real actual PEOPLE. Look, I taught too, and half the time our sim models didn't work.

 

Its definitely not like the real thing.

But practice on real people has consequences, none which risk management is going to swallow. So sim training is becoming the norm. It does at least provide an initial controlled environment to get the jitters out and provide a safe arena to provide constructive criticism in. Looking back at my practicing on real people days, I would have given anything to have had a few encounters in the sim lab prior to fumbling along like I did.

Regards

G Brothers PA-C

[LESH]

"Joelseff and Paula the clinical doctorate is coming. It is actually here just not entry level programs yet."     When?  Will PAEA support and accredit programs?  

 

When I cannot tell you. One of the things that needs to be addressed is having enough PA faculty with the terminal degree to teach in a doctoral program. The same problem that Nursing ran into. As soon as you see those numbers reach a critical mass then a major hurdle has been overcome. That has nothing to do with PAEA, that is an issue of meeting the standards of the various regional accrediting bodies of academic institutions. There already are members in PAEA who support the move to the terminal degree, but to do it now might put a whole lot of faculty out of work. They need the credential. PAEA in my experience does what the majority of the membership wishes. As far as accrediting programs PAEA doesn't do that.

[LESH]

I think Lesh was talking about the Baylor/army DSc program, which involves 18 months of training and a research project.

also do a search here for the new postgrad DPAM program starting at a civilian school next year.

Yes, that was it EMED. That's what I meant about not being entry level. 

[rpackelly]

The IOM report does give support for interprofessional education and in some physician residencies, PA residents are treated like PG-1s and do the same work as interns and second years for the first 12-18 months and then get off the train at that stop, as was mentioned above.  If there was Medicare support for that it would be great, and PAs would be able to defer their loans for residency just like docs.  They would make living expenses and get the benefit of extra training, and the MD/DO residents would get the benefit of having a PA as a true colleague their first year, learning about their knowledge base, etc.   That experience would do quite a bit to making PAs acceptable as the GPs of the future.  As a matter of fact, if three years of medical school training becomes more commonplace, the education for a residency trained FM MD would be six years and four years for  PA, not a huge differential.  

[primadonna22274]

Residency deferment for student loans disappeared a few years ago. Mine come due in 6 mos.

Only good thing is income-based repayment which makes it manageable.